What sustains the healthcare workers? A qualitative study of occupational wellbeing in health and medical services

Abstract

Background

Occupational wellbeing among healthcare professionals is an essential determinant of organizational effectiveness and public health. Yet, in many healthcare systems, it remains overlooked, while chronic stress, policy instability, and limited resources undermine workforce sustainability.

Objective

This study aimed to explore the multidimensional factors that sustain or challenge occupational wellbeing among healthcare professionals in Iran.

Methods

A qualitative design was employed using purposive sampling to select 19 participants, including physicians, nurses, and mental health experts. Semi-structured interviews were conducted, and data were analyzed through thematic analysis guided by King and Horrocks’ framework, integrating inductive and deductive coding.

Results

Five interrelated domains were identified: psychological and emotional wellbeing, individual resilience and coping, organizational design and leadership, healthcare-specific stressors, and socio-cultural influences. These dimensions interacted dynamically, shaping professionals’ sense of autonomy, mastery, solidarity, and purpose. While workload, systemic instability, and policy ambiguity eroded wellbeing, resilience was strengthened through spirituality, collegial support, and family networks.

Conclusion

Occupational wellbeing is best understood as a dynamic, holistic process shaped by structural, psychological, and cultural factors. Sustainable improvement requires human-centered management that emphasizes supportive leadership, organizational culture, and systemic redesign to foster resilient, creative, and purposeful healthcare professionals.

Keywords

occupational wellbeing healthcare workforce qualitative research organizational psychology Iranian healthcare system thematic analysis

Introduction

Healthcare professionals’ wellbeing is a critical yet often under-addressed component of health systems worldwide. Despite major efforts to improve quality of care and patient safety, comparatively less attention has been paid to the wellbeing of healthcare professionals who sustain these systems. Wellbeing is a multifaceted phenomenon that is central to developing healthy workplaces and maintaining a stable workforce. A widely used multidimensional model describes wellbeing in terms of physical, emotional, social, and financial wellbeing, work–life balance, and meaning in work.¹ This perspective emphasizes the complexity of wellbeing and the contribution of each dimension to how employees make sense of their experiences at work.

In healthcare settings, professional wellbeing has also been described as a multidimensional construct comprising job satisfaction, interpersonal relationships, autonomy, and opportunities for professional growth—factors that influence long-term professional sustainability.² However, much of the existing literature has tended to focus on discrete outcomes such as burnout, stress, and dissatisfaction without offering an integrated framework that connects organizational, psychological, social, and system-level determinants.^3,4 Moreover, studies are often insufficiently sensitive to cultural and institutional variations across contexts, even though such variations may shape both the sources of strain and the resources available to healthcare workers.⁵

Recent research illustrates that occupational burnout and psychological distress among healthcare workers are not solely individual-level phenomena and are strongly shaped by workplace and contextual conditions. For example, moral distress, emotional exhaustion, unclear protocols, and perceived job risk have been reported as salient predictors of distress and burnout in different settings.^6,7 Cultural norms and social context also matter: collectivist values have been noted as shaping experiences of personal accomplishment under emotional exhaustion,⁸ while social stigmatization during public health crises has been linked to work burnout and wellbeing.⁹ In addition, discrimination and structural inequities have been reported as serious threats to healthcare workers’ mental wellbeing in some contexts.¹⁰ Together, these findings suggest that wellbeing is best understood as embedded in organizational, social, and institutional realities rather than as an isolated individual outcome.

At the same time, an increasing body of literature emphasizes the role of institutional support, training, and psychologically safe workplaces in strengthening employee wellbeing.¹¹ Individual-level supports such as meditation and e-health interventions have been shown to reduce depression and burnout in some studies.¹² Organizational practices—including performance appraisal, career development, organizational support, and job flexibility—have also been associated with higher job satisfaction and improved wellbeing.^13–16 Yet implementation challenges remain; for example, inadequate worker involvement in wellbeing programs and lack of necessary infrastructure have been observed as barriers to sustained impact.^17,18

Accordingly, while mindfulness and stress-reduction programs are frequently recommended, evidence regarding their long-term effectiveness may be limited when structural and cultural determinants are not adequately addressed.^19,20 Likewise, global policies have sometimes shown inconsistent effects due to implementation gaps and insufficient cultural sensitivity.²¹ These issues underscore the need for models and interventions that are simultaneously structural, organizational, and culturally informed and that capture interactions among the variables shaping wellbeing.^22–25

Wellbeing among healthcare workers has direct implications for quality of care, organizational performance, and staff retention in health and care organizations.^26,27 Without evidence-based interventions, health systems may be strained by chronically stressful work conditions and rising job insecurity.²⁸ In response, this study applied a qualitative thematic analysis approach using in-depth interviews to explore determinants of occupational wellbeing in the Iranian healthcare system and to propose a context-specific framework integrating cultural, structural, and human elements.

While existing wellbeing models describe multiple dimensions of wellbeing (e.g., Wieneke et al.’s six-dimension model),¹ they are often applied as descriptive taxonomies and may not fully explain how wellbeing is produced through interacting conditions in specific institutional and cultural contexts. The present study contributes by developing a context-sensitive thematic framework grounded in interviews with Iranian healthcare workers. Our framework clarifies (i) how macro-structural constraints and organizational practices shape healthcare-specific demands, (ii) how leadership and HR-related processes influence perceived control and coping capacity, and (iii) how socio-cultural resources (e.g., spirituality, altruistic values, and family/peer support) can buffer—or sometimes intensify—the impact of systemic pressures. This interaction-based account extends beyond listing wellbeing dimensions by specifying linkages among determinants and providing actionable implications for management and policy in the Iranian healthcare system.

Materials and methods

This research used thematic analysis following the King and Horrocks method to investigate occupational wellbeing in Iranian health care professionals. Thematic analysis is a qualitative, systematic technique for searching and analyzing patterns and meanings in text data.²⁹ The King and Horrocks method is best suited to interview-based studies, allowing explicit and implicit themes to be elicited within the limits of an agreed analytical framework.³⁰ Compared to more conventional content analysis, it values recursive data-driven coding, which makes it possible to find emergent themes and enables researcher reflexivity.³¹

Data were gathered through 19 semi-structured interviews with healthcare professionals using purposeful sampling. Inclusion criteria were

(1) Occupational skill (i.e., doctors, nurses, and mental health professionals),

(2) At least 5 years of relevant work experience, and

(3) Organizational and institutional diversity (such as hospitals, treatment facilities, and health research centers).

Semi-structured interviews were conducted with healthcare professionals between October 2024 and May 2025. Interviews were held in-person in a private room at the workplace, lasted approximately 60–75 min, and were audio-recorded with participants’ permission. Recordings were transcribed verbatim, and transcripts were anonymized by removing identifiable information. The interview guide focused on participants’ experiences of occupational wellbeing, key stressors and resources, and contextual (organizational and socio-cultural) influences; the semi-structured interview guide is provided in Appendix A.

The sample size was determined based on the principle of theoretical saturation. Theoretical saturation was assessed concurrently with data collection and analysis and was considered achieved when consecutive interviews yielded no new codes or meaningfully distinct categories. After the later interviews, no new codes emerged; additional interviews were conducted to confirm the stability of the thematic structure.³² Participant characteristics are summarized in Table 1.

Table 1.

Demographic characteristics of study participants.

Participant characteristic	Categories	Frequency (n)	Percentage (%)
Gender	Female	15	79.0
Gender	Male	4	21.0
Educational level	Bachelor’s degree	13	68.5
	Master’s degree	4	21.0
	Doctorate	2	10.5
Age range	30–40 years	12	63.0
	41–50 years	5	26.5
	51–60 years	2	10.5
	Over 60 years	0	–
Years of professional experience	<10 years	10	52.5
	10–20 years	7	37.0
	20–30 years	2	10.5

Data were analyzed using King and Horrocks’ thematic analysis in an iterative and interpretive process. First, transcripts were read repeatedly for familiarization and initial descriptive coding.³³ Second, codes were compared across transcripts and clustered into candidate categories and sub-themes through constant comparison.³⁴ Third, higher-order themes were refined and relationships among themes were mapped to build an integrative thematic framework.³⁵

After finalizing the codebook and the five main themes, we developed thematic maps to visualize the analytic outputs.³⁶ Specifically, Figure 1 presents the integrative conceptual framework by depicting recurrent relationships among the five themes, reflecting participants’ accounts that wellbeing emerges through interactions rather than isolated factors. Figure 2 situates these themes within the Iranian healthcare context by linking macro-structural conditions (e.g., policy instability and resource constraints), meso-level organizational processes (e.g., leadership and staffing), and micro-level individual resources (e.g., coping). The depicted links were derived from patterns that repeatedly co-occurred across interviews and were refined through team discussion by revisiting the underlying transcripts to ensure that each relationship shown was grounded in the data.

Figure 1.

Holistic and network-based conceptual framework of the study.

Figure 2.

Thematic mapping within the cultural and organizational context of the Iranian healthcare system.

Coding was led by the first author. To support coding coherence and codebook refinement, a subset of transcripts (6 of 19) was independently coded by two experienced qualitative researchers and compared with the primary coding. Agreement for this subset was assessed using Cohen’s kappa (κ = 0.60). Discrepancies were discussed until consensus was reached, and resulting decisions were incorporated into subsequent coding iterations and documented in the audit trail.

Trustworthiness

Trustworthiness was enhanced using established criteria for qualitative research (credibility, dependability, confirmability, and transferability).³⁷ Credibility was supported through member checking: preliminary codes and the emerging thematic structure were shared with four participants, and their feedback was incorporated into subsequent analytic cycles. Dependability was addressed by providing a transparent account of participant selection, demographic characteristics, and the data collection and analysis procedures. Confirmability was strengthened by maintaining an audit trail documenting coding decisions, revisions, and analytic memos across iterations, and by using illustrative participant quotations in the Results to demonstrate grounding of interpretations in the data. Transferability was supported through rich contextual description and by comparing the findings with prior studies conducted in similar settings.

Reflexivity was addressed through regular analytic memoing and team discussions that explicitly considered how prior assumptions about wellbeing and healthcare work could shape interpretation. During analysis, discrepant cases were actively sought and revisited in the original transcripts to challenge emerging explanations and refine theme boundaries.

Ethics

As per ethical research protocols, informed consent was solicited from all subjects before conducting the study. Confidentiality and anonymity were ensured strictly throughout the study. Ethical clearance was also achieved from appropriate academic centers in order to adhere to professional norms of research.³⁸

Results

The interview transcripts were thematically analyzed using King and Horrocks’ approach. The analysis yielded five interrelated themes (Table 3), and Table 2 provides examples of preliminary categories and illustrative core codes. Table 2 illustrates how preliminary categories and core codes were derived from the raw data, whereas Table 3 summarizes the finalized themes and sub-themes; illustrative quotations are presented in the narrative Results sections below.³⁹

Table 2.

Preliminary thematic categories and sample core codes.

Intermediate categories	Sample core codes
Psychological wellbeing and work-related emotions: This category includes codes that directly relate to participants’ psychological, emotional, and affective experiences—such as mental fatigue, job anxiety, demotivation, and burnout. These reflect internal stressors arising from the individual’s interaction with their work environment.	Burnout; chronic anxiety; mental fatigue; persistent demotivation; feelings of worthlessness in the workplace; concerns about job security; need for recovery time; lack of control; sense of meaninglessness; internal satisfaction with performance; nighttime cognitive tension
Organizational structure and environmental constraints: This category emphasizes external factors such as organizational characteristics, policies, and processes that create dissatisfaction, stress, or detachment. These may also impact employees’ psychological and social wellbeing.	Non-transparent managerial decisions; role ambiguity; workforce shortages; lack of support resources; inefficient administrative processes; unfair task distribution; absence of effective incentive systems; rigid, inflexible regulations
Interpersonal relationships in the workplace: This category focuses on the nature and quality of social interactions among colleagues, managers, and within teams. These dynamics significantly shape perceptions of wellbeing, both psychologically and in terms of job satisfaction.	Emotional support from coworkers; unhealthy competition; harmful rumors; feeling ignored by supervisors; inter-departmental conflicts; empathetic collaboration; workplace camaraderie; mutual respect; sense of team belonging; lack of constructive dialogue culture
Work–Life Balance: This category reflects the interaction between professional duties and personal life. Lack of clear boundaries or adequate time for self and family contributes to diminished wellbeing.	Inability to attend to family; working late hours; insufficient leave; lack of time for recreation or exercise; constant interference of work in personal life; excessive self-sacrifice
Personal and professional growth: This category addresses opportunities or barriers related to skill development, learning, and career progression. A sense of growth and learning is closely linked to professional wellbeing.	Participation in workshops; problem-solving skill development; increased confidence through training; need for mentoring and guidance
Meaning and value in work: This theme captures how individuals assign meaning to their work and whether their personal values align with organizational missions. Misalignment may result in a loss of purpose or ethical conflict.	Finding meaning through helping others; feeling useful in one’s professional role; perceived failure to fulfill professional mission; ethical concerns about the organization; valuing impact and contribution; conflict between personal and organizational values; drawing inspiration from long-term goals
Motivational and demotivating factors: This category includes elements that influence motivation to continue or disengage from professional roles. Neglecting these can lead to poor performance or attrition.	Lack of recognition; disregard for innovative ideas; absence of performance incentives; No clear career path; intrinsic motivation for positive impact; perceived job instability
Organizational policies and decision-making: This category refers to how the organization allocates resources, makes decisions, defines roles, evaluates performance, and manages its systems. These policies directly influence job satisfaction, fairness, security, and mental wellbeing.	Opaque decision-making; lack of responsiveness to employee feedback; focus solely on quantitative outcomes; prioritization of financial over staff wellbeing; policy instability

Table 3.

Themes and sub-themes derived from the analysis.

Theme	Sub-theme
Emotional and psychological wellbeing at work	Sense of organizational belonging
	Satisfaction with job meaning
	Feeling valued and appreciated
	Emotional exhaustion
Psychological resilience and coping strategies	Active and adaptive coping
	Family support as a resilience resource
	Religion and spirituality in stress reduction
	Perceived control vs. helplessness
Organizational structures, leadership, and management	Leadership style
	Participation in decision-making
	Professional growth pathways
	Instability in organizational policies
Healthcare-specific occupational stressors	Excessive workload and irregular shifts
	Exposure to death, illness, and pain
	Resource shortages (staffing/equipment/support)
	Role conflict and contradictory demands
Cultural and social influences on wellbeing	Iranian work culture and value of teamwork
	Cultural norms, altruism, and ethical commitment
	Social support from peers and family
	High societal expectations and guilt/inadequacy

As shown in Table 2, early coding captured both internal experiences (e.g., emotional fatigue, anxiety, and meaning) and external constraints (e.g., staffing shortages and opaque decisions), alongside relational dynamics (e.g., teamwork and conflict) and work–life interference. These preliminary categories provided the building blocks for consolidating higher-order themes.

Theme 1

Emotional and Psychological Wellbeing at Work: Participants described belonging and recognition as central to their day-to-day wellbeing, while emotional exhaustion emerged when they felt excluded or undervalued. For example, one participant stated: “When I feel excluded from decisions, it’s as if I don’t exist.” “The meaning of my work is what keeps me from quitting, not the salary or the title.” “A simple ‘thank you’ from my supervisor changes my whole day.”

Theme 2

Psychological Resilience and Coping Strategies: Participants reported coping through active self-regulation, family support, and meaning-based strategies such as spirituality. Examples included: “Talking to my family after shifts helps me recover emotionally.” “Faith helps me tolerate difficult situations and keep hope” “Having autonomy reduces stress more than any training session.”

Theme 3

Organizational Structures, Leadership, and Management. Accounts highlighted the importance of leadership style, participation in decisions, and stable policies in shaping motivation and distress. Examples included: “Good leadership gives psychological safety, not fear.” “Exclusion from decisions makes me disengage from the organization.” “Policy instability creates constant insecurity.”

Theme 4

Healthcare-Specific Occupational Stressors. High workload, irregular shifts, exposure to suffering, and resource constraints were repeatedly described as stress amplifiers. Examples included: “We are expected to do the work of two people.” “Repeated exposure to death gradually wears you down.” “Lack of equipment makes us feel powerless and ineffective.”

Theme 5

Cultural and Social Influences on Wellbeing. Teamwork norms, ethical commitment, and social expectations shaped how participants interpreted strain and persistence at work. Examples included: “A friendly atmosphere protects us from burnout.” “Helping others is part of our values, and it gives strength.” “High expectations create guilt and constant self-criticism.”

Discussion

This study suggests that occupational wellbeing among Iranian healthcare workers is shaped by dynamic interactions across (i) individual psychological resources, (ii) organizational and structural conditions, (iii) healthcare-specific occupational demands, and (iv) socio-cultural supports. As illustrated in Figures 1 and 2, the themes are best understood as interacting mechanisms across macro-structural, meso-organizational, and micro-individual levels within the Iranian healthcare context, with socio-cultural resources shaping how stressors are experienced and managed. Rather than treating wellbeing as a single outcome (e.g., burnout) or as a set of isolated dimensions, the findings point to a context-sensitive process in which organizational conditions influence the intensity of job demands and the availability of resources, while socio-cultural factors can buffer—or at times intensify—the impact of structural constraints. This interactive interpretation helps explain why similar job demands may produce different wellbeing experiences across settings and highlights the value of integrative approaches when designing interventions.

Importantly, the proposed framework does not merely restate wellbeing dimensions; it explains how wellbeing emerges from interactions among structural constraints, organizational/leadership processes, healthcare-specific demands, and socio-cultural resources in a particular context. In doing so, it complements dimensional models¹ by adding a mechanism-oriented account that can guide where interventions should be targeted (system/organization/team/individual) and how cultural resources may operate as moderators of work stress rather than as stand-alone factors.

Organizational and structural determinants

A prominent pattern in the interviews was the central role of structural and organizational conditions. Participants repeatedly described administrative centralization, constrained resources, policy instability, and economic pressures as upstream drivers that shape day-to-day work realities. These conditions were perceived to translate into heavier workloads, reduced autonomy, uncertainty about procedures and expectations, and diminished access to supportive infrastructures. In practice, this means that individual coping efforts often occur within a system that may continuously replenish stressors; therefore, sustainable wellbeing improvement requires attention to organizational design, clarity, and stability rather than relying solely on individual-level strategies.

Healthcare-specific occupational demands

Beyond general organizational stressors, participants emphasized healthcare-specific demands that can uniquely erode wellbeing. These included irregular shifts and fatigue, high emotional labor, exposure to suffering and death, time pressure in patient care, and the perceived consequences of errors. Such demands were described as cumulative rather than episodic, gradually reducing recovery capacity and increasing emotional exhaustion. From an intervention standpoint, these accounts underscore the importance of workforce planning, scheduling practices that protect recovery time, and institutional supports for emotionally demanding clinical encounters (e.g., debriefing, peer support, and psychologically safe reporting systems).

Socio-cultural supports and resilience resources

Alongside stressors, participants described socio-cultural resources that were experienced as meaningful supports. Altruistic professional values, spirituality, and support from family and peers were often presented as protective factors that helped workers endure difficult conditions and restore a sense of purpose. These supports appeared to function as “meaning resources” that can strengthen perseverance and emotional regulation, especially when formal organizational resources are scarce. At the same time, reliance on socio-cultural coping alone may risk normalizing overload (e.g., “enduring hardship as a virtue”), which suggests that organizations should respect these resources while avoiding policies that implicitly shift responsibility for wellbeing entirely onto individuals.

Moral distress and identity tensions

A recurrent theme across accounts involved tensions between professional ethics, patient needs, and institutional constraints—experienced as moral distress and identity conflict. Participants described feeling caught between competing expectations (e.g., quality care vs limited resources or administrative demands), which undermined wellbeing even when they remained highly committed to their work. These findings point to the need for ethical support mechanisms and leadership practices that acknowledge value conflicts, provide transparent decision rationales, and offer forums for safe dialogue about dilemmas. Addressing moral distress is not only an individual matter; it is strongly shaped by organizational policies, resource allocation, and the degree of voice that healthcare workers have in decisions affecting care.

Implications for management and policy

Taken together, the findings suggest that effective wellbeing strategies should be multi-level and culturally and structurally sensitive. At the system and organizational levels, priorities include: stabilizing and clarifying policies, strengthening staffing and resource availability, improving fairness and transparency, and fostering supportive leadership and respectful inter-professional climates. At the team level, strengthening communication, mutual support, and conflict resolution can directly affect daily experiences of wellbeing. At the individual level, training and supports that enhance coping and recovery can be beneficial, but they are most effective when paired with organizational conditions that reduce chronic overload and improve predictability and control.

Strengths, limitations, and future research

A key strength of this study is the inclusion of diverse healthcare roles and rich qualitative accounts, enabling a context-sensitive interpretation of occupational wellbeing in Iranian health services. Nevertheless, transferability should be considered in light of the sample profile: participants were predominantly female (79%), most held a bachelor’s degree (68.5%), and no participants were older than 60 years (Table 1), which may have shaped the experiences captured (e.g., gendered workplace exposures and early- to mid-career perspectives). As with qualitative research, the findings are intended to provide analytic insights rather than statistical generalization and reflect accounts within a specific socio-organizational context. Future research could examine whether these dynamics vary across provinces and organizational types, recruit more gender-balanced and age-diverse samples, and use mixed-method or longitudinal designs to test pathways suggested by this framework (e.g., how leadership practices and policy instability influence moral distress and coping over time).

Figure 1 summarizes the final thematic framework derived from the interviews. The five themes are shown as interconnected domains to reflect that occupational wellbeing is shaped through interactions among organizational conditions, healthcare-specific demands, individual coping resources, and socio-cultural influences. The figure is intended as a high-level map; detailed interpretation and illustrative quotations for each theme are provided in the Results section.

Figure 2 situates the final themes within the Iranian healthcare context. It highlights how structural and organizational conditions (e.g., policy/economic pressure, centralized decision-making, and resource shortages) shape everyday work realities and amplify occupational stressors, while socio-cultural resources (e.g., family/peer support and religion/spirituality) can buffer stress and support coping. The figure also reflects value tensions (traditional–modern role conflict) that may contribute to moral distress and influence wellbeing experiences.

Conclusion

This research examined the determinants of occupational wellbeing among Iranian health workers and provided evidence for the multi-dimensionality of the inter-connection among individual, organizational, environmental, and cultural factors in this phenomenon.

Among the better-established consequences are organizational designs—work environment support, human resources, and leadership—that manage job satisfaction management and burnout.

Consistent with prior research, participants linked supportive leadership, fair workload distribution, and recognition to higher motivation and lower burnout risk, whereas authoritarian/passive management and unstable policies were described as undermining morale and job satisfaction.^40,41 In line with evidence that heavy workload, resource constraints, and irregular shifts are major drivers of psychological strain among healthcare workers, our data similarly showed that chronic overwork and perceived lack of control erode wellbeing and recovery capacity.^42–45

Beyond these general stressors, participants emphasized moral distress and role conflicts as particularly damaging when ethical expectations, patient needs, and managerial demands collide, underscoring the importance of ethical support systems and psychologically safe workplaces.^46,47 The study also highlights gendered vulnerabilities in workplace wellbeing (e.g., exposure to harassment/discrimination and unequal burdens), suggesting the need for gender-sensitive protections and support mechanisms.^48,16 Finally, our findings support a multi-level response in which organizational resources (e.g., training, fair appraisal, and HR system strengthening) are complemented by individual-level resilience and coping supports.^13,17,18,49

Lastly, considering Iran’s structural and cultural context—its vertically organized administrative system, constrained resources, and the salience of trust and altruism grounded in religious values—our findings point to a set of practical actions to strengthen occupational wellbeing among healthcare professionals. These actions include strengthening transformational and participatory leadership; improving work–life balance systems through more predictable scheduling, adequate staffing, and protected recovery time; establishing ethical support policies to address moral distress and role conflict; implementing dedicated support programs and protections for women healthcare workers; improving human resource systems (including fair appraisal and transparent workload allocation); using appropriate and innovative technologies for HR monitoring and early identification of wellbeing risks; providing coping skills and resilience training tailored to workplace realities; and developing supportive, psychologically safe work environments that promote collegial support, respectful communication, and timely conflict resolution.

Supplemental material

Supplemental material - What sustains the healthcare workers? A qualitative study of occupational wellbeing in health and medical services

Supplemental material for What sustains the healthcare workers? A qualitative study of occupational wellbeing in health and medical services by Abbas Nargesian, Maryam Mamipour Anaghez, Shayan Malekian, Hossein Imani, and Saeid Heydari in Human Systems Management.

Footnotes

Acknowledgments

The authors would like to thank the participants for their willingness to participate to this study.

ORCID iD

Hossein Imani

Ethical considerations

This study was conducted in accordance with institutional and international ethical guidelines.

Consent to participate

Informed consent was obtained from all participants.

Author contributions

All authors contributed to the study conception, data collection, analysis, and manuscript preparation. All authors read and approved the final manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The data supporting the findings of this study are available from the corresponding author upon reasonable request.*

Supplemental material

Supplemental material for this article is available online.

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